Ventilator Dependence Risk Score for the Prediction of Prolonged Mechanical Ventilation in Patients Who Survive Sepsis/Septic Shock with Respiratory Failure

Ya-Chun Chang, Kuo-Tung Huang, Yu-Mu Chen, Chin-Chou Wang, Yi-Hsi Wang, Chia-Cheng Tseng, Meng-Chih Lin, Wen-Feng Fang, Ya-Chun Chang, Kuo-Tung Huang, Yu-Mu Chen, Chin-Chou Wang, Yi-Hsi Wang, Chia-Cheng Tseng, Meng-Chih Lin, Wen-Feng Fang

Abstract

We intended to develop a scoring system to predict mechanical ventilator dependence in patients who survive sepsis/septic shock with respiratory failure. This study evaluated 251 adult patients in medical intensive care units (ICUs) between August 2013 to October 2015, who had survived for over 21 days and received aggressive treatment. The risk factors for ventilator dependence were determined. We then constructed a ventilator dependence (VD) risk score using the identified risk factors. The ventilator dependence risk score was calculated as the sum of the following four variables after being adjusted by proportion to the beta coefficient. We assigned a history of previous stroke, a score of one point, platelet count less than 150,000/μL a score of one point, pH value less than 7.35 a score of two points, and the fraction of inspired oxygen on admission day 7 over 39% as two points. The area under the curve in the derivation group was 0.725 (p < 0.001). We then applied the VD risk score for validation on 175 patients. The area under the curve in the validation group was 0.658 (p = 0.001). VD risk score could be applied to predict prolonged mechanical ventilation in patients who survive sepsis/septic shock.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Of the 379 patients who were diagnosed with sepsis/septic shock with respiratory failure between August 2013 and October 2015, 251 patients were included in the final analysis.
Figure 2
Figure 2
Of the 321 patients who were diagnosed with sepsis/septic shock and respiratory failure between November 2015 and November 2016, 175 patients were included for further analysis as the validation group.
Figure 3
Figure 3
Ventilator dependence risk score compared to PaO2/FiO2 subscore and GCS subscore on admission day 7.
Figure 4
Figure 4
Receiver operating characteristic curve of the ventilator dependence risk score for discrimination between patients with ventilator dependence and ventilator independence in the ICU in the validation group of 175 patients with sepsis/septic shock and respiratory failure.
Figure 5
Figure 5
(A) Ventilator dependence risk score in sepsis and septic shock patients in the cancer group revealed AUC = 0.745. (B) Ventilator dependence risk score in sepsis and septic shock patients in the chronic kidney disease group revealed AUC = 0.723.

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